Individual
XALEESE EVELYN KUEPPERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CST
Contact information
Practice address
12265 VENTURA BLVD STE 107, STUDIO CITY, CA 91604-2530
(310) 691-5411
Mailing address
23808 BRESCIA DR, VALENCIA, CA 91354-3000
(310) 691-5411
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
152799
SURGICAL TECHNOLOGIST
CA
Enumeration date
10/17/2019
Last updated
10/17/2019
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